The role of nurse case managers in workers’ compensation claims in Georgia entails many responsibilities, both in patient care and claim oversight.
These duties can benefit workers by coordinating timely medical treatment, but may also create challenges if the insurance company uses their documentation to dispute your claim. An experienced workers’ compensation lawyer can address conflicts with nurse case managers and protect you throughout the claims process.
What is a Nurse Case Manager?
A nurse case manager is generally a registered nurse employed by the employer’s workers’ compensation insurer to oversee the medical care of injured workers. The nurse case manager can schedule appointments, get prescription medications, and obtain work restrictions.
They can also act as a liaison between the injured worker’s doctors and the insurance company.
How a Nurse Case Manager Can Affect Your Georgia Workers’ Compensation Case
Having a nurse case manager for workers’ compensation handling your claim can benefit you.
For example, they can facilitate appointment scheduling, obtain the information required to process your claim, answer any questions you may have, and develop a plan to help you return to your regular job duties.
However, a nurse case manager’s role also involves acting on behalf of your employer’s workers’ compensation insurance company. Their assessments can affect how your claim is handled, such as controlling costs or making referrals to medical providers who tend to release patients to work rapidly.
Potential Conflicts of Interest With Nurse Case Managers
You may have a conflict of interest with your nurse case manager if they try to stop treatment before you’re fully healed or discourage you from seeking a second opinion.
Additionally, your nurse case manager may share details from your doctor visits with the insurance carrier or try to influence the provider’s decisions regarding treatment or impairment ratings in ways that could reduce your workers’ comp benefits.
Your Rights When Dealing With a Nurse Case Manager
In most cases, you are not legally required to work with a nurse case manager.
Either you or your attorney must provide written consent for a nurse case manager to attend your medical appointments, and you have the right to withdraw consent at any time.
Even so, a nurse case manager may still coordinate care or communicate with the insurance company behind the scenes while overseeing your claim. Under Georgia law, they also do not need your consent to talk to your treating physician about planning and assessing the options for your medical treatment.
What to Do If a Nurse Case Manager Oversteps
If you believe the nurse case manager has overstepped their role, your first action should be to revoke your consent for them to work on your case.
Document your request for privacy and for minimal intervention from the nurse case manager. Ask your lawyer to contact the insurer and explain your concerns and why you think the nurse case manager could harm your case.
When to Speak With a Georgia Workers’ Compensation Lawyer
It’s a good idea to consult a Georgia workers’ compensation lawyer right after you suffer a workplace injury.
If you haven’t done that, you should contact such a knowledgeable attorney immediately after the workers’ compensation insurer assigns a nurse case manager to your claim.
The experienced workers’ compensation attorneys at Underwood Law LLC can help you monitor the insurer’s use of a nurse case manager in your claim and protect your right to benefits. Call our law firm or contact us online today for a free consultation.
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